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Health Leaders Media: Strategies to Close the Racial Disparity in PAD Care

Aug 14, 2018

Addressing the racial disparity in peripheral artery disease care can include data-driven performance improvement efforts and targeting high-risk patients for treatment at high-quality hospitals.

Significant racial disparities exist in the treatment of peripheral artery disease (PAD), and low-performing regions of the country should launch care improvement initiatives to help close the gaps, researchers say.

The disparity between black patients and white patients was particularly stark for short-term PAD outcomes such as amputation and major adverse limb events (MALEs), the researchers wrote in an article published this month in the Journal of Vascular Surgery.

“These differences in short-term outcomes likely reflect the effect of differences in local factors, such as access to care, insurance status, and treatment at high-volume centers, all of which varied significantly across regions.”

The researchers studied data from 90,418 patients, 17% of whom were black. For the regional analysis, the country was segmented into 18 regions.

The disparity in amputation rates was glaring, the researchers wrote.

“As black patients were less likely to present in follow-up, they likely experience even higher rates of amputation and limb events relative to white patients. Our sensitivity analysis reveals that amputation rates could be as high as almost double the rates experienced by white patients.”


In addition to facing higher risk in general for adverse short-term outcomes, black patients faced variable risks in several regions of the country:

  • Three regions had significantly higher adjusted mortality rates than the other regions

  • Two regions had significantly lower adjusted rates of MALE

  • One region had significantly lower adjusted amputation rates

  • Three regions had significantly higher adjusted amputation rates

The existence of regional variation in PAD care is consistent with earlier research in multiple surgical disciplines, the researchers wrote.

“A wealth of evidence demonstrates that geographic and regional variation influences healthcare costs, utilization, treatment strategies, and outcomes. In recent years, an increased focus on regional variation in surgical practice revealed that where a patient resides often has an impact on the patient’s propensity to undergo surgery or amputation more than the actual surgical indication.”


The researchers say health systems and hospitals can pursue several strategies to address disparities in PAD care:

  • Use data from the Society for Vascular Surgery Vascular Quality Initiative to compare outcomes results with other regions and surgical centers. The data can support quality improvement initiatives and encourage adoption of best practices.

  • Earlier research has shown that blacks are more likely than whites to live near high-quality hospitals, but they are more likely to receive care at low-quality hospitals. To address PAD care disparity, healthcare providers should target high-risk patients for treatment at high-quality hospitals with high service volume.

  • Underperforming regions should launch care improvement initiatives such as boosting access to care.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.

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